The fact of the bile becoming, under certain circumstances, highly acrid and deleterious, has been seized by the humoral pathologist as a powerful argument in support of his doctrines. Amongst the more distinguished authors who have fully treated this subject, and maintained that our secretions may thus become acrid poisons, we have Galen[[160]], Aretæus[[161]], Fernelius[[162]], Morgagni[[163]], Hebenstreit[[164]], Hilchen[[165]], Hoffman[[166]], Baumer[[167]], Belloc[[168]], Alibert[[169]], Foderé[[170]], Mahon[[171]], De la Mettrie[[172]], and Tronchin[[173]]. Some of the authors above enumerated have expressed their opinions in the strongest terms; thus Morgagni (loco citato) “Facile agnosco a prava ipsa corporis dispositione internum aliquando posse venenum gigni;” and Hebenstreit observes, “Possunt omnino in corpore venena nasci, atque ipsi humores vitales vim vasa sua destruendi sæpe acquirunt.[[174]]” Hilchen, after attempting to establish a diagnosis between the effects of poison, and those arising from a morbid degeneracy of the fluids, exclaims, apparently in despair, “Inquilinos corruptosque humani corporis humores, eum acrimoniæ gradum, eamque corrodendi vim acquirere posse, quæ eosdem edat effectus, quos venena corrosiva sistunt, eamdem sordium vomitu rejectarum putrilaginem, fætorem, haud dissimilem, et acerrimam, et pelves arrodentem acrimoniam certum est.” And Plouquet, after describing all the phenomena of poisoning, concludes by acknowledging “Probe autem notandum hæc omnia etiam ex aliis statibus morbosis nasci posse.” De la Mettrie also has observed upon this question, “Il est prouvé que la bile se peut changer dans nos corps en espece d’Arsenic!” Our own countryman, Dr. Currie[[175]], has furnished the public with an opinion upon the subject under discussion, and he states his belief that, under a peculiar state of irritation, the biliary organs may secrete a bile of so very acrid a nature as to excite an almost immediately fatal impression upon the alimentary canal, especially when suddenly effused, and in a highly concentrated form.
We have deemed it right to adduce these various authorities, in relation to the important question before us, still, however, reserving our opinion, that the physician will on such occasions, by means of the subsidiary sources of discrimination above enumerated, generally be enabled to form a diagnosis[[176]] which, although it may not amount to certainty, must be considered as capable of increasing the weight of the general mass of circumstantial evidence.
As the medical treatment to be adopted in cases of acute disease, or poisoning, can hardly be considered a subject of Medical Jurisprudence, we should have passed it over in silence, did not the evidence delivered upon the trial of Donnall imperiously call upon us for some animadversion; and we feel it our painful duty upon this occasion to observe, that the whole tenor of the medical defence displayed a very unbecoming contest; the witnesses conducted themselves like advocates, raising doubts, and defending their positions with a pertinacity that belongs to those who seek triumph rather than truth.
In the cure of cholera the experience of the physicians of all ages wholly concurs. In the commencement of the disease the evacuation of the redundant bile is to be favoured by the plentiful exhibition of mild diluents, and after the redundant bile has been thus eliminated, or when the spasmodic affections of the alimentary canal become dangerously violent, opiates, in sufficiently large doses, but in small bulk, may be administered. To employ evacuants, as Sydenham quaintly observes, “is to increase the disturbance, and as it were, to endeavour to quench fire by oil; and on the other hand, to commence with opiates is shutting up the enemy in the bowels.” Under such authority, we presume, one of the witnesses in the defence of Donnall, felt justified in condemning the practice of the respectable physician who attended the deceased (Appendix, p. 304); but we here see a witness assuming as a fact, what was never proved in evidence, and then deducing conclusions from it. Dr. Edwards informed the court that “there were no symptoms of cholera morbus when he saw Mrs. Downing; but from what he heard of her complaint, he imagined that there was something offensive either in the stomach or bowels, which ought to be evacuated.” (Ibid. p. 286.)
Nor are the symptoms produced by the operation of narcotic poisons so distinct as to escape the possibility of being confounded with those of spontaneous disease. They may, for instance, simulate those of apoplexy, or epilepsy; but the history of the case, the odour of the breath, and the subsequent examination of the body after death, will generally clear up the difficulties which may at first present themselves. But we shall have occasion to consider this subject hereafter; the difficulties of the case are well illustrated by the evidence on the trial of Donellan, for the murder of Sir Theodosius Boughton, with laurel water, for which see Appendix, p. 243.
Before we quit the subject which involves the consideration of our fluids degenerating, under particular circumstances, into poisons, we may just notice the opinion of some foreign chemists, that in certain diseases the Prussic acid[[177]] is generated in some of the fluids of the animal body. We are not inclined to accede to this proposition, because during life we do not think the chemical decompositions, known to be necessary for the production of this substance, can ever take place. At all events, it must be preceded by a state of the system which would necessarily prevent the chance of any medico-judicial fallacy.
Q. II. Whether organic lesions, similar to those produced by poisoning, may not occasionally result from natural causes?
In entertaining this question, we are prepared to meet with numerous alleged difficulties; but as many of them appear to have arisen, rather from the ignorance or carelessness of the operator, than from the natural obscurity of the subject itself, we are inclined to hope that by getting rid of the former source of fallacy, we shall be enabled to examine with some satisfaction and advantage, those which, in a greater or less degree, will be liable to baffle the researches of the more experienced anatomist.
Such are the changes which an animal body undergoes after death, that unless the anatomist be intimately acquainted with their nature and extent, it is impossible that he should be able to derive any safe conclusions from his dissection; thus, said Mr. John Hunter, we may see appearances which are natural, and may suppose them to have arisen from disease; we may see diseased parts, and suppose them to be in a natural state, and we may suppose a circumstance to have existed before death, which was, in reality, a consequence of it; or we may imagine it to be a natural change after death, when it was truly a disease of the living body. It is not difficult, therefore, to perceive, how a person in such a state of ignorance must blunder, when he attempts to connect the appearances in the dead body, with the symptoms that were observed during life; and indeed it may be safely asserted, that the great utility of anatomical inspections depends upon the accuracy, judgment, and sagacity with which such comparisons are made. In our chapter, on the art of conducting dissections, we have endeavoured to point out each fallacy which is likely to present itself to the inexperienced anatomist, we shall therefore confine ourselves, on the present occasion, to the consideration of those points whose obscurity must be admitted to belong intrinsically to the subject, and to be wholly independent of the ignorance or skill of the dissector.
Amongst the signs of the action of poison on the human body, disclosed by the light of dissection, the separation of the villous coat of the stomach has been generally considered the most certain criterion. Hebenstreit, whose opinion has been adopted by Mahon, and many other forensic physicians, has delivered his unreserved judgment upon the question, in the following emphatic sentence. “Præterea sola atque infallibilis deglutiti veneni nota est, separata et veluti decorticata simulque cruenta interna ventriculi tunica: nam separatio ista supponit applicatam superficiei internæ ventriculi materiam fervidam, igni similem, quæ tunicam istam a substrata solvit vasculari nervea.”[[178]] In opposition to such an opinion, it is our duty to state that several cases stand recorded[[179]] in which the detachment of the villous coat of the stomach and intestines has taken place, without the slightest ground to suspect the administration of poison, while many vegetable poisons destroy life without occasioning any inflammation in the primæ viæ, and consequently leave no traces of disorganization. But there still remains another source of fallacy connected with the present question which demands a full and impartial inquiry, viz. that the gastric juice, by its action upon the dead stomach, can occasion such changes in structure, as may be mistaken for the effects of a corrosive poison; these changes are according to circumstances liable to vary in every possible degree of intensity, from the slight erosion of the interior villous coat of the stomach, as displayed by the smooth, thin, and more transparent condition of that viscus, to the destruction of all its membranes, and the production of large perforations in its great extremity. This phenomenon, the nature of which was first explained by Mr. John Hunter[[180]], depends upon the gastric juice, which the stomach secreted during life, becoming its solvent after death. Amongst the endless proofs which the history of the animal economy affords of that universal law by which chemical and vital forces are wisely preserved in a state of perpetual hostility, there is no illustration more striking and satisfactory, than that which is furnished by the phenomenon in question. If animals, or parts of animals, while possessed of the living principle, be taken into the stomach, they are not in the least affected by the solvent powers of its juices; thence it is that we so constantly find animals of various kinds living in the stomach, or even being hatched and bred there; but no sooner do these animals lose the living principle, than they become subject to the digestive powers of the stomach, and are accordingly dissolved, and assimilated. If it were possible, says Mr. Hunter, for a man’s hand to be introduced into the stomach of a living animal, and kept there for some considerable time, it would be found that the dissolvent powers of the stomach could produce no impression upon it; but if the same hand were separated from the body, and introduced into the same stomach, we should then find that this organ would immediately act upon it. Spallanzani, with a patience that almost wearies his readers, made many attempts at dissolving the stomach by its own juice, but succeeded satisfactorily in none; he proved, however, two important facts, first, that the process of digestion, or more correctly speaking, of solution, continues after death; and secondly, that the stomach itself is digestible. The truth of the first he demonstrated by introducing food into the stomach, after he had killed his animal; and that of the second, by giving the stomach of one dog to be devoured by another. The fact then is clearly established, that the stomach, after death, may be dissolved by its own juice[[181]]; and this may exist in its cavity, or be retained in the vessels which had secreted it. It remains for us then to examine the circumstances under which it is likely to occur, and the appearance by which it may be distinguished; and we may here be allowed to observe with an ingenious writer,[[182]] that were these points merely of a speculative nature, or were their decision a matter of mere curiosity, it would be idle to consume so much valuable time in their discussion; but when we remember that they are questions upon which the medical practitioner may be called upon to deliver a solemn opinion, in order to determine the fate of a criminal, they undoubtedly demand the highest attention of those who profess to aid the administration of Justice, by the lights of science. We have, therefore, first to inquire into the circumstances under which this natural erosion of the stomach is known to take place. Mr. John Hunter[[183]] details the history of three examples, in which the stomach was considerably perforated. Two of the men had died shortly after having their skulls fractured, and the third was a man who had been hanged, so that in each of these cases the person had been deprived of life by violence; whence Dr. Adams[[184]] inferred, that Mr. Hunter limited the action of the gastric juice on the stomach to such as died from violent and sudden causes; and many physiologists have, accordingly, supposed that solution of the coats of the stomach never takes place, except where the person has died suddenly; this, however, is an inference, as Mr. Burns[[185]] has very justly observed, “by no means warranted by the general tenour of Mr. Hunter’s essay,” indeed he expressly states, that “there are few dead bodies in which the stomach is not, at its great end, in some degree digested;” “and any one,” continues Mr. Hunter, “who is acquainted with the art of dissection, can easily trace the gradations from the smallest to the greatest.” The consideration of the vast importance of this fact, and frequent opportunities of investigating the subject, induced Mr. Burns to collect the observations which he had made during the dissection of those bodies in which he found the stomach digested; and these observations, he informs us, have led him to conclude, that the phenomenon in question is neither so rare in its occurrence as some have imagined, nor confined to such subjects as had been, previous to death, in a healthy condition; they have also convinced him, that other parts of the stomach, besides the large end, may be occasionally acted on by the gastric juice. “That the digestion of the coats of the stomach after death is not a very rare occurrence, I think myself authorised to infer, from my having examined nine bodies in which the solution had proceeded to such an extent as to have made holes of considerable size through that viscus; and, besides these nine instances in which the digestion of part of the stomach was complete, I have had occasion to see, in opening this viscus, various degrees of dissolution of its villous coat.”[[186]]